Artery disease a major global challenge
RESEARCHERS have warned of major global health challenges ahead due to a dramatic increase in the number of people with peripheral artery disease (PAD). In a systematic review published in The Lancet, researchers from around the world including Australia, found the number of people living with PAD had increased by nearly a quarter between 2000 and 2010 to an estimated 202 million people. They found 69•7% lived in low- or middle-income countries (LMIC), an increase of 28•7% over the decade. The number in high-income countries (HIC) increased by 13•1% in the same period. The authors wrote that longer life expectancy and changing lifestyles appeared to be driving the rise in PAD rates, with a greater than 35% increase in cases among those older than 80 years worldwide. Smoking was an important risk factor, followed by diabetes, hypertension and hypercholesterolaemia. “In view of the association of peripheral artery disease with loss of mobility, functional decline, and cardiovascular events, this dramatic increase in the number of people living with peripheral artery disease represents a major public health challenge”, the researchers wrote. “Interventions are urgently needed to reverse these trends both in LMIC and HIC. The numbers are likely to grow substantially in the future, especially in LMIC, where much research is required on the social and economic burden as well as strategies for optimum treatment and prevention.” An accompanying commentary said the research “almost certainly underestimates the true burden” of PAD as it only used the ankle-brachial index to detect the disorder. “When any disease affects more than 200 million people, it is time to take action to prevent and control its global burden”, the authors wrote.

Significant decline in Indigenous infant mortality
INFANT mortality in Australia’s Indigenous population has declined by 46% in the 10 years to 2010, according to the first annual report on the health indicators in the Indigenous Early Childhood Development National Partnership Agreement published by the Australian Institute of Health and Welfare. The report showed the gap between mortality rates for Indigenous and non-Indigenous infants had narrowed by 74% between 2001 and 2010. Between 2000 and 2009, the proportion of low birthweight babies born to Indigenous mothers declined by 7.1%, and there was a significant narrowing of the gap between low birthweight babies born to Indigenous and non-Indigenous mothers. Other findings in the report showed Indigenous teenagers were 30 times more likely than other teenagers to have syphilis, almost five times more likely to have contracted chlamydia, and 58 times more likely to have contracted gonorrhoea. Although rates of hepatitis B and hepatitis C were 2–6 times higher among Indigenous teenagers than other teenagers, between 1997–99 and 2009–11, there was a significant decline in rates of hepatitis B (78%) and hepatitis C (69%) among Indigenous teenagers, and a significant narrowing of the gap between the rates of hepatitis B and hepatitis C among Indigenous and other teenagers.

BP visit variability linked to cognition
HIGHER visit-to-visit variability in blood pressure independent of average blood pressure is associated with worse cognitive performance in older people at high risk of cardiovascular disease, according to research published in the BMJ. The research involved 5461 people with a mean age of 75.3 years and at risk of cardiovascular disease. Their blood pressure was measured every 3 months during an average of 3.2 years. Average systolic and diastolic blood pressure over the period were 153.1 mm Hg and 82.5 mm Hg, respectively. The researchers found that higher visit-to-visit variability in systolic and diastolic blood pressure was associated with worse performance in different domains of cognitive function and lower hippocampal volume and risk of cortical infarcts. Higher variability in diastolic blood pressure was associated with risk of cerebral microbleeds. “These associations were independent of various cardiovascular risk factors, in particular average systolic and diastolic blood pressures”, the authors wrote. They speculated that changes in hippocampal volume and occurrence of cortical infarcts and cerebral microbleeds might be candidate pathogenic mechanisms behind the association.

Strong breastfeeding–IQ link
RESEARCHERS have reported that their results “support a causal relationship” between breastfeeding, and superior receptive language at age 3 years and verbal and non-verbal IQ at school age. The findings, published in JAMA Pediatrics, showed longer duration and greater exclusivity of breastfeeding were associated with the improvements. The prospective US cohort study enrolled prebirth mothers and followed up children to age 7 years. The researchers also found that beneficial effects of breastfeeding at age 3 years seemed greater for women who consumed two or more servings of fish a week compared with those who consumed less than two servings a week. Breastfeeding duration was not associated with Wide Range Assessment of Memory and Learning scores. The researchers wrote that their findings supported national and international recommendations to promote exclusive breastfeeding until 6 months of age and continuation of breastfeeding until at least age 1 year. An accompanying editorial said: “Let’s allow our children’s cognitive function be the force that tilts the scale, and let’s get on with it”.

Dry eye affects pain threshold
A STRONG association has been found between high pain sensitivity, low pain threshold and the pain symptoms of dry eye disease (DED), according to research in JAMA Ophthalmology. The population-based cross-sectional study of 1635 female UK twins aged 20–83 years found that those with DED showed significantly lower heat pain threshold (HPT) scores and lower heat pain suprathreshold (HPST) scores than those without DED. Participants with an HPT below the median had DED pain symptoms more often than those with an HPT above the median (31.2% vs 20.5%). “This study [adds] to previous associations among the severity of tear insufficiency, cell damage and psychological factors”, the authors wrote. “Management of DED symptoms is complex, and physicians need to consider the holistic picture, rather than simply treating ocular signs.”


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